Scientists seek acough remedy thatreally delivers relief

By Laura Beil
Each year more than 26 million people in the United States go to a doctor complaining about a cough. Most have colds and
will just have to wait it out. Other people cough because they have allergies,
asthma, bronchitis, pneumonia or even
cancer. In rare instances, there is no
known culprit — a person simply starts
coughing and can’t stop.

a viral infection such as the commoncold (green) can lead to irritated andinflamed airways—and a nasty cough.

the last few years have yielded significant
insights into cough science, encouraging
more researchers and pharmaceutical
companies to have a look. (Given how
much money is spent on cough suppressants, pharmaceutical companies recognize that a better, safer syrup would be a
blockbuster.)

Studies so far have found molecular
on-and-off cough switches on the surface of the respiratory tract, although
none have yet led to new
cough medicines. New findings also show that coughing
is a complicated event that
shares some of the same
neural circuitry with other
basic body functions, like
pain and temperature sensitivity. And brain scans are
revealing a neural network
for coughing that goes beyond a mindless impulse.

“It’s been a remarkable decade,” says
Brendan Canning, a pulmonologist at
the Johns Hopkins Asthma and Allergy
Center in Baltimore. In 2005, a new
scientific journal, called Cough, was
launched in response to a sudden burst
of interest in the field.

Current cough syrups also have the
potential to be addictive, which makes
policy makers and doctors hesitant to
rely on them. Prescription drug abuse
with opiates has become a national epidemic in the United States, and some
lawmakers have moved to ban the sale
of over-the-counter cough syrups to
minors to prevent teens from getting
high on dextromethorphan.

A new approach to cough treatment
could more directly act in the
airways or could still target
the brain, but without such
widespread side effects. But
here’s the tricky part: Coughing is the body’s mechanism
for defending its lungs, so a
medicine can’t work too well
for the body’s own good.

“There’s a devastating
need for new drugs,” Dicpinigaitis says.

People plagued with constant coughing
get so desperate for relief, he says, that
he occasionally walks into his New York
office and sees suitcases in the waiting
room from out-of-state patients who
have Googled him and come for a visit.
“Most cough is acute cough associated
with the common cold,” he says. “But in
a subgroup of those folks, the cold comes
and goes, but the cough comes and stays.”
Some of his patients have spent more than
a decade watching their sleep and social
lives dwindle from too much coughing.

A new cough remedy might be easier
to find if coughing were an easier thing to
study. Rats and mice, the standard models
in medical research, don’t cough the way
people do. Even animals that do readily
cough go quiet when placed under anesthesia, just like people. When an awake
volunteer in an MRI scanner coughs,
it’s challenging to keep the person still
enough to get a good image of the brain.

“It’s been hard going, and for years
there was no fruit coming from people’s